STATE MENTAL· HQSPITALS REPRINT FlROM THE BIENNIAL REPORT OF THE JOINT STATE GOVERNMENT COMMISSION GENERAL ASSEMBLY OF THE OOMMONWEALTH OF PENNSYLVANIA 1959 1961 In view of constantly changing techniques for treat­ to 20 outpatient psychiatric clinics, and special facilities ment of the mentally ill, the Executive Committee for research, training, and teaching are available at the directed a study of the expendi~res and costs of State Western State Psychiatric Institute in Pittsbm:gh, leased mental hospitals. to the University of Pittsburgh, and the Eastern Penn­ sylvania Psychiatric Institute in Philadelphia, operated The 17 Commonwealth-operated mental"hospitals have by the Department of Public Welfare. In summary, a total of 43,919 beds, of which 30,457 are "suitable," State-owned mental hospitals are not the only facilities 10,641 are "unsuitable," and 2,821 are "excess." 19 for the mentally ill in Pennsylvania, but, in terms of Twenty private mental hospitals with a total bed capacity capacity, they far outrank all other .facilities combined. 6f 2,185, of which 666 are "suitable" and 1,519 "unsuit­ able," are located within the Commonwea'lth. Federal Table 1 shows for the biennia 1947-1949 through hospitals for mentally ill veterans have a bed capacity 1957-1959 total expenditures,21 institutional receipts and of, 3,618.20 Inpatient facilities for the mentally ill are net Commonwealth expenditures for the State mental available at 19 general hospitals which provide 1,278 hospitals. Over the period under review, total expendi­ beds for mental patients, of which 885 are "suitable" tures increased from $46.6 million to $114.2 million, or and 393 are "unsuitable." State financial aid is provided 145 percent. Net Commonwealth expenditures increased from $41.0 million to $97.5 million, or 138 percent. In­ stitutional receipts-that is, patient charges-accounted 19"Suitable" beds ,are defined by the Pennsylvania Department of Public Welfare as "those housed in fire resistive construc­ for 15 peTcent of total expenditures in 1957-1959 as com­ tion in which frames, Hoors, wall, permanent partitions and roof pared with 12 percent in 1947-1949.22 are built of stone, brick, steel, or reinforced concrete; i.e., with­ out any wood except doors or triin." "Unsuitable" units are UTotal expenditures consist of disbursements from appro~ those not in such construction. "Excess" beds are beds located priations made to the Department of Public Welfare for operat­ in space not designed as patients' quarters. Unless otherwise ing expenses and current capital accounts and do not include noted, all data were furnished by the Department of Public funds spent at State mental hospitals by the General State Au­ Welfare. thority for additions, betterments and replacements which have amounted to about five percent of total expenditures. 20 American Hospital Association, Hospitals, "Guide Issue, Journal of the American Hospital Association, Part Two (Au­ 22 An insignificant portion of institutional receipts is accounted gust 1960). for by receipts other than patient charges. Table 1 EXPENDITURES AND RECEIPTS OF STATE MENTAL I-IOSPITALS 1947-1949 THROUGH 1957-1959 Institutional Net Commonwealth Total Receipts Expenditures Biennium Expenditures Percent Percent Amount of Total Amount of Total (1) (2) (3) (4) (5) (6) 1947-1949 $46,626,429 $5,631,141 120/0 $40,995,288 88% 1949-1951 54,065,780 6,816,699 13 47,249,081 87 1951-1953 68,578,036 8,866,221 13 59,711,815 87 1953-1955 84,993,455 11,241,105 13 73,752,350 87 1955-1957 100,755,118 13,030,977 13 87,724,141 87 1957-1959 114,200,658 16,747,756 15 97,452,902 85 [1]' Table 2 shows the location of the 17 State mental 10sis patients from outside their service areas. hospitals, their current service areas, and the average Examination of Table 2 shows that between 1947-1949 number of patients at each hospital23 during the biennia and 1957-1959 the average number of patients in all 1947-1949 and 1957-1959. Generally speaking, admis­ mental hospitals increased from 35,539 to 38,744, or 9 sions to mental hospitals are limited to residents of their percent. In 14 of the 17 hospitals, average patient popu­ service areas, except for Farview, Norristown, Mayview lation increased between the two biennia, with the three and Philadelphia. Farview is an institution for criminally smallest hospitals showing the largest proportionate in­ insane males and receives patients from the entire state; creases. In both periods, hospitals varied markedly in Norristown, Mayview and Philadelphia admit tubercu- size; patient population ranged from 287 to 6,015 in 23 Average number of patients is computed by the Department 1947-1949 and from 754 to 6,430 in 1957-1959. of Public Welfare by averaging patient counts taken at the be­ ginning, middle and end of a biennium. State mental hospital expenditures are customarily Table 2 LOCATION, SERVICE AREA, AND AVERAGE NUMBER OF PATl~NTS STATE MENTAL HOSPITALS Average Number State Mental Counties in of Patients County Service Area Hospital 1947-1949 1957-1959 (I) '(2) (3) (4) (5) Allentown Lehigh Carbon, Lehigh, Monroe, 2,002 1,778 Northampton, and part of Bucks Clarks Summit Lackawanna Bradford, Lackawanna, Pike, 1,308 1,3)8 Wayne Danville Montour Clinton, Columbia, Lycoming, 2,408 2,641 Montour, Northumberland, Susque- hanna, Snyder, Sullivan, Tioga, Union, Wyoming, and part of Schuylkill Dixmont Allegheny Beaver, Lawrence 981 957 Embreeville Chester Chester, Delaware 287 777 Farview . Wayne All counties 1,171 1,338 Harrisburg Dauphin Adams, Cumberland, Dauphin, 2,447 2,660 Franklin, Fulton, Juniata, Lancaster, MifBin, Perry, York Hollidaysburg Blair Blair, Bedford, Centre, 359 763 Huntingdon, and part of Cambria Mayview Allegheny Part of Allegheny (Pittsburgh) 3,046 3,191 Norristown Montgomery Montgomery, part of Bucks, and 4,310 4,491 part of Philadelphia Philadelphia Philadelphia Part of Philadelphia 6,015 6,430 Retreat Luzerne Luzerne 1,1l2 1,124 Somerset Somerset Fayette, Somerset 443 754 Torrance Westmoreland Armstrong, Butler, Greene, 2,614 2,999 Indiana, Washington, Westmoreland, and part of Cambria Warren Warren Cameron, Clarion, Clearneld, 2,671 2,992 Crawford, Elk, Erie, Forest, Jefferson, McKean, Mercer, Potter, Venango, Warren Vvernersville Berks Berks, Lebanon, and part of 1,869 1,771 Schuylkill Woodville Allegheny Part of Allegheny (excluding 2,496 2,740 Pittsburgh) All Hospitals 35,539 38,744 [2] presented· in terms of average biennial expenditure per except Farview. 25 For all hospitals combined, ~verage patient whioh is obtained by dividing total expenditures biennial expenditure per patient increased from $1,302 by average number of patients. This measure, however, is to $2,943, or 126 percent, and average biennial expendi­ of limited usefulness in evaluating expenditures, since it _ ture per patient treated increased from $946 to $1,988, or does not reflect patient turnover. The average number 110 percent. The smaller increase in average biennial of patients is not indicative of -the number of individual expenditure per patient treated indicates an increase in patients who have received care and treatment during the over-all patient turnover rate. Individual hospitals the period. In 1957-1959 average number of patients as showed strikingly different relationships between average a proportion of the number of patients treated varied biennial expenditure per patient and average biennial among hospitals, ranging from 45 to 79 percent. Average expenditure per patient treated. For instance, in 1957­ 1959, Hollidaysburg and Embreeville had above-average bi;~"1iial expenditure per patient treated 24 relates total biennial expenditures per patient but below-average bi- expenditures <to the number of individual patients, re­ ennial expenditures per patient treated. Again, in 1957­ gardless of length of stay, who were treated during the 1959, Philadelphia State Hospital had the lowest average biennium. biennial expenditureper patient, but its average biennfal Table 3 shows, for 1947-1949 and 1957-1959, average expenditure per patient treated exceeded that of seven other institutions. biennial expenditure per patient and average biennial expenditure per patient treated for all mental hospitals In addition to the changes in average biennial expendi­ ture per patient and average biennial expenditure per patient treated, the period under review has been 24 Average biennial expenditure per patient treated is com­ characterized by significant changes in t:he relative im- puted by dividing total biennial expenditures by the number of patients treated defined as the number in the. institution at the 25 Subsequent analyses of State mental hospitals apply to all beginning of the biennium plus the number admitted during the ho!;pitals except Farview, which is excluded because of its atypi- biennium. cal patient population. Table 3 AVERAGE BIENNIAL EXPENDITURE PER PATIENT AND AVERAGE BIENNIAL EXPENDITURE PER PATIENT TREATED 1947-1949 AND 1957-1959 Average Biennial Average Biennial State Mental Expenditure Expenditure Per Hospital Per Patient Patient Treated 1947-1949 1957-1959 1947-1949 1957-19S9 (1) (2) (3) (4) (5) All Hospitals . $1,302 $2,943 $ 946 $1,9R8 Allentown . 1,266 3,549 850 2,485 Clarks Summit . 1,209 3,300 783 2,104 Danville ; . 1,474 2,849 1,058 1,691 Dixmont : . 1,618 3,114 1,499 2,465 Embreeville . 1,738 4,104 1,279 1,858 Harrisburg . 1,161 2,659 845 1,791 I-Iolliday<;burg ,' . 1,253 3,230 803 1,897 Mayview - . 1,470 3,025 966 1,916 Norristown ; . 1,203 2,912 896 2,055 Philadelphia . 1,138 2,570 958 2,001 Retreat . 1,392 3,443 1,065 2,320 Somerset . 1,207 3,448 1,023 2,282 - Torrance . 1,186 2,810 814 2,020 Warren ................•............- . 1,340 3,013 857 1,803 Wernersville . 1,295 2,801 879 1,922 Woodville .